HCC scores have been used since 2004 by Medicare to adjust payments based on the risk level of the enrollee. This has resulted in Medicare paying a higher monthly capitation fee for patients with higher HCC scores as these patients require more resources and disease intervention. The HCC payment system uses ICD-10 codes and demographics to generate a risk adjustment factor (RAF) score which identifies patients that require higher cost to care for and is based on the diagnosis codes billed in the previous review period.
The new MACRA implementation has brought about nothing but chaos and confusion among medical practitioners, and more so for cardiovascular specialists. MIPS (Merit Based Incentive Payment System) is the new payment model that is geared towards a value-based payment rather than the existing service based model. This shift comes with a number of changes that a medical practitioner has to incorporate into his practice in order to ensure that the revenue is not amiss.
Understanding net collection rates will help you to gain a better understanding of how much money that is owed to your practice is collected. Calculating your collection rate is quite simple, but it offers an excellent understanding of where your business stands and how you can improve it through medical billing operations.
Calculating your Net Collection Rate
The net collection rate holds a barometer to the health of your medical practice.
MACRA replaces the service based payment with the value-based payment system. This change has brought about a number of challenges for the physicians, which they have to overcome in order to continue to have a hassle-free practice. Some of the most common challenges that a physician has to overcome when dealing with MACRA are as follows:
Staying aware of the MACRA and MIPS details
Despite having come into practice in 2015,
CMS seems to have done a complete turn-around since its 2016 release of mandating MACRA participation, especially for the Advanced Alternative Payment Models (APMs). As of this year, over 800,000 clinicians are not expected to comply with the MACRA MIPS reporting, which could have potentially saved them million in compliance costs.
Who are exempt,
Healthcare practitioners have always been welcoming to new technological developments that assure better care facilities for their patients. Telemedicine care is one such improved technological advancement that has played an important role in how patients interact with their physicians.
A survey by the Nemours Children’s Health systems showed that the telemedicine in the pediatricmedical field is steadily increasing.
Electronic Health Records (EHR) effectively refers to the digitization of the patient’s information charts for archival and retrieval purposes in future. This digitized information is easy to access, even from remote locations, thus ensuring that the physician has accurate information about the patient’s medical history at his fingertips at all times.
The tactful benefits offered by digitization of patient records have pushed physicians to aggressively adopt EHR in their practices.
Medicare Access and Chip Reauthorization Act (MACRA) will have a tremendous impact on the business and health care models in healthcare establishments throughout the country. MACRA is being implemented partially in most establishments voluntarily, to get a taste of what is yet to come and is expected to be fully implemented by the end of 2018.
The Health Insurance Portability and Accountability Act (HIPAA) is a set of viable guidelines that dictates the security of health information which is stored/ transmitted via an electronic medium. These guidelines are subject to change in a timely fashion and the medical practitioners ought to keep themselves updated with these changes and ensure that their billing is compliant with the HIPAA security standards.
Revenue cycle management (RCM) refers to the financial process of keeping track of a patient’s expenses during their stay at the healthcare facility. The health care facility employs the use of advanced billing software to manage the entirety of the billing, right from the registration of a patient to the final payment, in an effective manner.